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General NPI Number Information
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NPI Number | 1376896779
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Entity Type | Organization
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Legal Business Name | PLEASANT VALLEY CHIROPRACTIC AND SPORTS MEDICINE
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Dates
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Enumeration Date | 10/23/2012
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Last Update Date | 10/23/2012
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Provider Practice Location Address
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Address Line | 11720 E WILSON RD
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City | STOCKTON
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State | IL
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Zip | 61085-9547
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Country | US
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Telephone | 815-947-6026
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Fax |
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Provider Business Mailing Address
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Address Line | 11720 E WILSON RD P.O.BOX 134
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City | STOCKTON
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State | IL
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Zip | 61085-9547
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Country | US
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Telephone | 815-947-6026
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. PETER F. ZID
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Credential | D.C.
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Telephone | 815-947-6026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 36007442
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License Number State | IL
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